In Nigeria, health maintenance organizations (HMOs) are the purchasers of health insurance with a social National Health Insurance Scheme for civil servants. However the roles of HMOs in implementation of social health insurance are not clear. This study determined the roles of HMOs in implementation of the national social health insurance scheme in Enugu, Southeast Nigeria. A partially mixed sequential dominant status design was employed in the study. Quantitative data were collected from 613 Federal Government employees that are registered with the National Health Insurance Scheme (NHIS) as part of the Formal Sector Social Health Insurance Program (FSSHIP) using an interviewer-administered questionnaire. Test for sampling adequacy was ensured (KMO, 0.701) and likewise the sphericity of the data using Bartlett’s test (Chi [1] 796.72, p-value < 0.001). For the qualitative study, there was document review and in-depth interviews. A total of 28 in-depth interviews were conducted with key stakeholders comprising of managers of HMOs, NHIS manager, providers of health care and personnel in the State Ministry of Health among others. Thematic analysis was used for the qualitative data. One-third (31.5%) of respondents said that roles of HMOs were very important, while 23% said that their roles were not important. More than half (57.70%) ranked HMOs very low in their roles, while 24.10% ranked them highest. Concentration index shows that the poor were satisfied (−.10), while the rich were highly satisfied (0.13) with roles of HMOs. The qualitative data analysis showed that most of the respondents were not satisfied with the roles of HMOs based on the themes that were developed and analyzed. There is clear understanding of the functions of HMOs among respondents in the study although they generally think that HMOs are not meeting the expectations of the scheme. There is need for the Federal Government through the National Health Insurance Scheme to provide more effective guidelines for HMOs, supervise and monitor the implementation of such guidelines for HMOs to improve on their roles.

中文翻译：

---

尼日利亚东南部恩古格（Enugu）的健康维护组织在实施社会健康保险计划中的作用：混合方法调查。

在尼日利亚，健康维护组织（HMO）是购买健康保险的人，并为公务员制定了社会国民健康保险计划。然而，HMO在实施社会健康保险中的作用尚不清楚。这项研究确定了HMO在尼日利亚东南部Enugu实施国家社会健康保险计划中的作用。在研究中采用了部分混合的顺序优势状态设计。使用访谈员管理的问卷，从613名联邦政府雇员中收集了定量数据，这些雇员已在国民健康保险计划（NHIS）中注册，作为正式部门社会健康保险计划（FSSHIP）的一部分。确保进行抽样充分性检验（KMO，0.701），同样使用Bartlett检验检验数据的球形度（Chi [1] 796.72，p值< 0.001）。对于定性研究，需要进行文件审查和深度访谈。与关键利益相关者进行了总共28次深度访谈，这些利益相关者包括HMO经理，NHIS经理，卫生保健提供者以及国家卫生部的人员等。主题分析用于定性数据。三分之一（31.5％）的受访者表示，HMO的角色非常重要，而23％的受访者表示，其角色并不重要。超过一半（57.70％）的HMO角色排名很低，而24.10％的HMO排名最高。集中指数显示，贫困人口对HMO的满意度为-0.10，而富人对HMO的满意度为0.13。定性数据分析表明，大多数受访者对基于已开发和分析主题的HMO的作用不满意。尽管受访者普遍认为HMO不能满足该计划的期望，但他们对HMO的功能有清晰的了解。联邦政府需要通过《国民健康保险计划》为HMO提供更有效的准则，监督和监督HMO实施此类准则以改善其作用。